[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4343 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 4343

To amend the National Organ Transplant Act to clarify the definition of 
 valuable consideration, to clarify that pilot programs that honor and 
promote organ donation do not violate that Act, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 23, 2023

 Ms. Matsui (for herself and Mr. Wilson of South Carolina) introduced 
 the following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
To amend the National Organ Transplant Act to clarify the definition of 
 valuable consideration, to clarify that pilot programs that honor and 
promote organ donation do not violate that Act, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Organ Donation Clarification Act of 
2023''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) As of May 2023, 113,999 people await an organ 
        transplant, with 95,957 of those people waiting for a kidney, 
        and average wait times are approaching five years for a kidney, 
        with over one-and-a-half times as many people being added to 
        the waiting lists as getting a transplant.
            (2) Of the nearly three million Americans who die annually, 
        under 30,000, representing about one percent of all deaths each 
        year, possess major organs healthy enough for transplanting.
            (3) On average, 17 people a day died while waiting for an 
        organ in 2020, with the majority of those people waiting for a 
        kidney.
            (4) In 2022, approximately 4,498 people were removed from 
        kidney waiting lists and approximately 1,500 from liver 
        (1,123), heart (239), and lungs (145) waiting lists because 
        they became permanently too sick to receive a transplant.
            (5) Over 75 percent of dialysis patients are not employed 
        because dialysis requires multiple treatments per week which 
        last several hours and leave patients drained, thus creating a 
        huge financial burden on the patients, their families, and the 
        government; moreover, lost tax revenue from these individuals 
        is not included in the cost estimates above.
            (6) A patient receiving a kidney transplant, and thus no 
        longer needing dialysis, can enjoy a much higher quality of 
        life for another 10-15 years on average.
            (7) As medical advances extend people's lives on dialysis, 
        the number of patients on dialysis will increase significantly, 
        as will the costs for individuals and the Federal Government.
            (8) Roughly seven percent of the Medicare budget goes to 
        the End Stage Renal Disease Program, with dialysis costing 
        Medicare over $90,000 per patient per year, as Federal law 
        dictates that Medicare will cover dialysis for everyone who has 
        made minimal Social Security tax payments.
            (9) A kidney transplant pays for itself in less than two 
        years, with each transplant saving an average of $136,000 in 
        medical costs over a 10-year period, 75 percent of which is 
        savings to the taxpayers.
            (10) Experts project that if the supply of transplant 
        kidneys could be increased to meet the demand, taxpayers would 
        save more than $16,000,000,000 per year in medical costs.
            (11) The World Health Organization estimates that 10 
        percent of all transplants take place on the international 
        black market, the last choice for desperate patients facing an 
        alternative of death, however recipients often receive infected 
        kidneys and suffer poor health outcomes and donors are often 
        victimized.
            (12) Present policy on domestic donation has never been 
        subject to studies or pilots to determine effectiveness in 
        increasing the availability of donated organs and the 
        effectiveness of safeguards that prevent coercion or 
        exploitation, precludes all but altruistic donation, 
        prohibiting any form of incentive or benefit for donors.
            (13) In 2010, Israel implemented sweeping changes to its 
        national organ donation program including reducing financial 
        burdens on donors, giving future transplantation priority to 
        registered organ donors and their families, and promoting 
        donation by reimbursing the donor's medical costs, 40 days of 
        lost wages, and five years of medical and life insurance costs, 
        and as a result saw organ donation approximately triple over a 
        10-year period.
            (14) Experts are arriving at a consensus that trials are 
        necessary to find new methods of promoting additional organ 
        donation which will save lives and reduce organ trafficking.

SEC. 3. CLARIFICATION OF CERTAIN PROVISIONS OF THE NATIONAL ORGAN 
              TRANSPLANT ACT.

    (a) Valuable Consideration.--Section 301(c)(2) of the National 
Organ Transplant Act (42 U.S.C. 274e(c)(2)) is amended to read as 
follows:
            ``(2) The term `valuable consideration' does not include 
        the following:
                    ``(A) Reasonable payments associated with the 
                removal, transportation, implantation, processing, 
                preservation, quality control, and storage of a human 
                organ.
                    ``(B) Advanced payments or reimbursement for 
                travel, lodging, food during travel, and other 
                logistical expenses related to donation.
                    ``(C) Advanced payments or reimbursement for 
                dependent care expenses related to donation before, 
                during, or after the donation, but not later than the 
                date that is 10 years after the date of the donation.
                    ``(D) Advanced payments or reimbursement for lost 
                wages related to donation.
                    ``(E) Medical expenses related to donation and all 
                related follow-up care including preventative follow-up 
                care and medication for up to a 10-year period.
                    ``(F) Paperwork or legal costs related to donation.
                    ``(G) Any term life insurance policy against the 
                risk of death or disability as a result of donating an 
                organ or the longer-term health effects of having 
                donated an organ, that--
                            ``(i) in the case of a life insurance 
                        policy, provides for payments in amounts less 
                        than $2,000,000, adjusted annually for 
                        inflation; and
                            ``(ii) in the case of a disability 
                        insurance policy, provides for payments equal 
                        to or less than the reasonable earnings 
                        expectations of the donor.''.
    (b) Covered Pilot Program.--Section 301 of the National Organ 
Transplant Act (42 U.S.C. 274e) is amended by adding at the end the 
following:
    ``(d) Covered Pilot Program Encouraging Organ Donation.--
            ``(1) Approval.--The Secretary may approve covered pilot 
        programs for purposes of applying the exception in paragraph 
        (2).
            ``(2) Exception to prohibition.--Subsection (a) does not 
        prohibit--
                    ``(A) acquisition, receipt, or transfer of any 
                noncash benefit provided pursuant to a covered pilot 
                program; or
                    ``(B) other actions taken to carry out a covered 
                pilot program.
            ``(3) Definitions.--In this subsection:
                    ``(A) The term `covered pilot program' means a 
                pilot program that--
                            ``(i) is conducted by the Federal 
                        Government or any State, territory, Tribe, or 
                        local government;
                            ``(ii) is approved by the Secretary under 
                        paragraph (1);
                            ``(iii) is subject to an ethical review 
                        board process;
                            ``(iv) has a term of not more than 5 fiscal 
                        years;
                            ``(v) is for the purpose of providing, or 
                        allowing the provision of, noncash benefits for 
                        organ donation and organ donors, and measuring 
                        the effects of providing such noncash benefits;
                            ``(vi) measures the effects of providing 
                        such noncash benefits; and
                            ``(vii) allows for the determination of the 
                        recipient of an organ donated pursuant to the 
                        covered pilot program--
                                    ``(I) in the case of organs from 
                                deceased donors, only by the Organ 
                                Procurement and Transplantation 
                                Network; and
                                    ``(II) in the case of nondirected 
                                organs from living donors, only by a 
                                transplant center that is a member of, 
                                and abides by the rules and 
                                requirements of, the Organ Procurement 
                                and Transplantation Network established 
                                pursuant to section 372 of the Public 
                                Health Service Act.
                    ``(B) The term `noncash benefit' means any benefit 
                or thing of value received by an organ donor that is 
                impossible to sell, trade, or otherwise transfer to 
                another individual.
            ``(4) Report to congress.--Not later than three years after 
        the Secretary first approves a covered pilot program, and every 
        three years thereafter until there is no longer a covered pilot 
        program in operation, the Secretary shall submit a report to 
        the Congress on--
                    ``(A) the impact of covered pilot programs on the 
                organ pool;
                    ``(B) the demographics of the donors participating 
                in covered pilot programs;
                    ``(C) the demographics of the recipients of organs 
                donated by participants in covered pilot programs;
                    ``(D) the effectiveness, fairness, and 
                equitableness of the distribution of nondirected living 
                donor organs that are donated by participants in 
                covered pilot programs; and
                    ``(E) recommendations to Congress on--
                            ``(i) improving covered pilot programs; and
                            ``(ii) expanding the use of noncash 
                        benefits to incentivize organ donation.''.
    (c) Relationship to Payments by Recipient of Organ.--Subsection (d) 
of section 377 of the Public Health Service Act (42 U.S.C. 274f(d)) is 
amended to read as follows:
    ``(d) Relationship to Payments Under Other Programs.--An award may 
be made under subsection (a) only if the applicant involved agrees that 
the award will not be expended to pay the qualifying expenses of a 
donating individual to the extent that--
            ``(1) payment has been made, or can reasonably be expected 
        to be made, with respect to such expenses--
                    ``(A) under any State compensation program, under 
                an insurance policy, or under any Federal or State 
                health benefits program; or
                    ``(B) by an entity that provides health services on 
                a prepaid basis; or
            ``(2) the recipient of the organ has made payment, or had 
        agreed to make payment, with respect to such expenses.''.
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